The implementation of the Medicare Part D benefit has stirred the emotions of both the academic and professional pharmacy communities. With the inclusion of a small provision within the Medicare Modernization Act (MMA), a whirlwind of activity has been initiated. To many, the medication therapy management (MTM) provision is a panacea: recognition of the pharmacist's role in medication management and the payment system to compensate for it. Many pharmacy organizations and individuals see MTM as the opportunity for pharmacy to shine in the context of care delivery. However, shortcomings of the law and implementing rules, lack of programmatic definition to guide the drug plans, and dependence on drug plans to explicitly include and cover pharmacist face-to-face patient interaction have failed to quell the expectations of a large portion of the profession. The cries of “pharmacists must be paid for delivery of services before they will provide them” have been answered with only the potential of payment for delivering unspecified services to an undefined population of patients at a payment level yet to be negotiated with drug plans.
The hollow nature of the harangue that “we must be paid before we provide services” provides little or no incentive for federal, state, or local policymakers to respond to the “payment for services” mantra. Academic pharmacy has actually created programs and care delivery models, but they are not reflected in the advocacy efforts of the profession. Advocating for both the academy and the profession through examples with significant associated outcomes, academic pharmacy is making inroads into the policy world. The strength of the effort is the continued allegiance of the academy to the principles outlined in the papers of the Commission to Implement Change.1-4 The tradition-breaking dedication of the academy to educating a health care professional competent and committed to the delivery of pharmaceutical care is carrying the profession further than it realizes.
Strength-based advocacy depends on bringing to the policy table positive examples of change: academic pharmacy has developed clear strengths that are now positioning the academy for effective advocacy efforts. The policy agenda important to academic pharmacy which focuses on teaching, research, and service, is moving the profession of pharmacy towards the shared vision of a care environment in which the pharmacist is inextricably linked with the prescriber and patient in medication decision making. The downstream events associated with poor prescription drug decisions could be ameliorated to a large extent with the placement of the pharmacist directly at the side of the prescriber and patient as the prescribing decisions are made. The issues of medication safety, misuse, adherence, and the very need for the prescription could all be modified to result in improved patient care if a pharmacist was part of the renewed calls for patient-centered, team-based care. Let us be honest, this type of practice is already a reality. There are physician practices that employ a pharmacist to improve patient care through this type of model. Members of the American Association of Colleges of Pharmacy (AACP) are developing academic detailing programs with self-insured employers. Colleges and schools have developed successful telemedicine and shared-position programs that ensure continued access to comprehensive pharmacy services in rural communities. The Department of Health and Human Services authorized a series of important demonstration projects that created similar practice plans within community health centers. As an indicator of success, some of these projects have continued beyond the funding period. The pharmacist is being paid, but where are these examples in the advocacy efforts of the profession?
The AACP is increasing the awareness of how colleges and schools of pharmacy are leading the way in creating a health care professional that is essential in the prescription drug use decision-making and medication management processes. Through a strength-based advocacy agenda, AACP is bringing to the attention of policymakers the positive results of our members' activities. In the context of the current issues important to both the academy and the profession, let us compare the respective approaches.